Federal Nursing Home Reform Act from the Omnibus Budget Reconciliation Act of 1987 or simply OBRA ‘87 SUMMARY Developed by Hollis Turnham, Esquire In 1987, President Ronald Reagan signed into law the first major revision of the federal standards for nursing home care since the 1965 creation of both Medicare and Medicaid 42 U.S.C1396r, 42 U.S.C. 1395i-3, 42 CFR 483. The landmark legislation changed forever society’s legal expectations of nursing homes and their care. Long term care facilities wanting Medicare or Medicaid funding are to provide services so that each resident can “attain and maintain her highest practicable physical, mental, and psycho- social well-being.” Medicaid Provision: 42 U.S.C. 1396r(b)(4) http://www4.law.cornell.edu/uscode/42/1396r.html Medicare Provision: 42 U.S.C. 1395i-3(b)(4) http://www4.law.cornell.edu/uscode/42/1395i-3.html Federal Regulations: 42 CFR 483.25 http://www.access.gpo.gov/nara/cfr/cfr- retrieve.html - page1 (Use the search engine at the bottom of the page to retrieve a specific title part and section.) WHAT IS OBRA '87? The Federal Nursing Home Reform Act or OBRA ‘87 creates a set of national minimum set of standards of care and rights for people living in certified nursing facilities. This landmark federal legislation comes by its common name “OBRA” through the legislative process. Congress, then and now, usually completes a huge measure of its budgetary and substantive work in one large bill. The bill accomplishing that function in 1987 was entitled the Omnibus Budget Reconciliation Act of 1987 or “OBRA ‘87.” The separate Federal Nursing Home Reform Act along with many other separate bills was “rolled into” one bill to insure final passage of all the elements. These minimum federal health and care requirements for nursing homes are to be delivered through variety of established protocols within nursing homes and regulatory agencies. And as minimum standards, Long-Term Care Ombudsmen should view OBRA as a baseline that should be built upon to reach not only resident “well-being” but also happiness and fulfillment. OBRA also recognized the unique and important role performed by the LTCOP for nursing home residents. The federal Medicaid and Medicaid legislation included those http://www4.law.cornell.edu/uscode/42/1396r.html http://www4.law.cornell.edu/uscode/42/1395.html http://www.access.gpo.gov/nara/cfr/cfr-retrieve.html#page1 http://www.access.gpo.gov/nara/cfr/cfr-retrieve.html#page1 distinct advocacy roles and subsequent regulations and other guidance has given LTCOPs additional tools to serve resident interests. The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include: • Emphasis on a resident’s quality of life as well as the quality of care; • New expectations that each resident’s ability to walk, bathe, and perform other activities of daily living will be ma ...

1. Federal Nursing Home Reform Act
from the
Omnibus Budget Reconciliation Act of 1987
or simply
OBRA ‘87 SUMMARY
Developed by Hollis Turnham, Esquire
In 1987, President Ronald Reagan signed into law the first
major revision of the federal
standards for nursing home care since the 1965 creation of both
Medicare and Medicaid
42 U.S.C1396r, 42 U.S.C. 1395i-3, 42 CFR 483. The landmark
legislation changed
forever society’s legal expectations of nursing homes and their
care. Long term care
facilities wanting Medicare or Medicaid funding are to provide
services so that each
resident can “attain and maintain her highest practicable
physical, mental, and psycho-
social well-being.”
Medicaid Provision: 42 U.S.C. 1396r(b)(4)
http://www4.law.cornell.edu/uscode/42/1396r.html
Medicare Provision: 42 U.S.C. 1395i-3(b)(4)
http://www4.law.cornell.edu/uscode/42/1395i-3.html
Federal Regulations: 42 CFR 483.25

2. http://www.access.gpo.gov/nara/cfr/cfr-
retrieve.html - page1 (Use the search engine at the bottom of
the page to retrieve a
specific title part and section.)
WHAT IS OBRA '87?
The Federal Nursing Home Reform Act or OBRA ‘87 creates a
set of national minimum
set of standards of care and rights for people living in certified
nursing facilities. This
landmark federal legislation comes by its common name
“OBRA” through the legislative
process. Congress, then and now, usually completes a huge
measure of its budgetary and
substantive work in one large bill. The bill accomplishing that
function in 1987 was
entitled the Omnibus Budget Reconciliation Act of 1987 or
“OBRA ‘87.” The separate
Federal Nursing Home Reform Act along with many other
separate bills was “rolled
into” one bill to insure final passage of all the elements.
These minimum federal health and care requirements for
nursing homes are to be
delivered through variety of established protocols within
nursing homes and regulatory
agencies. And as minimum standards, Long-Term Care
Ombudsmen should view OBRA
as a baseline that should be built upon to reach not only resident
“well-being” but also
happiness and fulfillment.
OBRA also recognized the unique and important role performed
by the LTCOP for
nursing home residents. The federal Medicaid and Medicaid

3. legislation included those
http://www4.law.cornell.edu/uscode/42/1396r.html
http://www4.law.cornell.edu/uscode/42/1395.html
http://www.access.gpo.gov/nara/cfr/cfr-retrieve.html#page1
http://www.access.gpo.gov/nara/cfr/cfr-retrieve.html#page1
distinct advocacy roles and subsequent regulations and other
guidance has given LTCOPs
additional tools to serve resident interests.
The changes OBRA brought to nursing home care are enormous.
Some of the most
important resident provisions include:
• Emphasis on a resident’s quality of life as well as the quality
of care;
• New expectations that each resident’s ability to walk, bathe,
and perform other
activities of daily living will be maintained or improved absent
medical reasons;
• A resident assessment process leading to development of an
individualized care
plan 75 hours of training and testing of paraprofessional staff;
• Rights to remain in the nursing home absent non-payment,
dangerous resident
behaviors, or significant changes in a resident’s medical
condition;
• New opportunities for potential and current residents with
mental retardation or

4. mental illnesses for services inside and outside a nursing home;
• A right to safely maintain or bank personal funds with the
nursing home; Rights
to return to the nursing home after a hospital stay or an
overnight visit with family
and friends The right to choose a personal physician and to
access medical records;
• The right to organize and participate in a resident or family
council;
• The right to be free of unnecessary and inappropriate physical
and chemical
restraints;
• Uniform certification standards for Medicare and Medicaid
homes;
• Prohibitions on turning to family members to pay for Medicare
and Medicaid
services; and
• New remedies to be applied to certified nursing homes that
fail to meet minimum
federal standards.
OBRA set in motion forces that changed the way state
inspectors approached all their
visits to nursing homes. Inspectors no longer spend their time
exclusively with staff or
with facility records. Conversations with residents and families
are a prime time survey
event. Observing dining and medications administration are a
focal point of every annual
inspection.

5. Under OBRA, Long Term Care Ombudsman Programs have
defined roles to fulfill and
tools to use in the annual inspection process to nurture the
conversations between
residents/families and inspectors and life in the nursing home.
HOW DID OBRA '87 COME ABOUT?
The federal Nursing Home Reform Act became law with
growing public concern with
the poor quality of care in too many nursing homes and the
concerted advocacy of
advocates, consumers, provider associations, and health care
professionals. Congress
asked the Institute of Medicine (IoM) to study how to better
regulate the quality of care in
the nation’s Medicaid and Medicare certified nursing homes.
In its 1986 report Improving the Quality of Care in Nursing
Homes, the expert panel
recommended:
• A stronger federal role in improving quality;
• Revisions in performance standards, the inspection process,
and the remedies to
improve nursing home services;
• Better training of nursing home staff;
• Improved assessment of resident needs; and
• A dynamic and evolutionary regulatory process.
Information can be found at:

6. http://www.nao.edu/books/0309026461
In order to assure implementation of the IoM recommendations
from the “blue ribbon
panel,” the National Citizens' Coalition for Nursing Home
Reform organized the
“Campaign for Quality Care” to support the federal reforms.
National organizations
representing consumers, nursing homes, and health care
professionals worked together,
and continue to work, to create consensus positions on major
nursing home issues. Their
consensus positions on the IoM report laid the foundation for
the federal law.
OBRA has changed the care and lives of nursing home residents
across America. There
have been significant improvements in the comprehensiveness
of care planning. Anti-
psychotic drug use declined by 28-36% and physical restraint
use was reduced by
approximately 40%.
Several states have taken all or parts of OBRA ‘87 and made
them state law for their
licensed nursing homes or other kinds of long term care
facilities. For example, the state
of Washington has extended the rights that nursing home
residents have to residents of all
Washington long term care facilities. RCW 70.129.005 And,
Michigan has incorporated
many of the OBRA prohibitions on Medicaid discrimination into
state law. MCLA
333.21765a.
Online Research: The links to federal laws and regulations in
this document have been

7. made to the most reliable sources known to the Ombudsman
Resource Center. Links to
the Medicaid and Medicare laws are made to the Legal
Information Institute maintained
by Cornell University. The federal code of regulations is
accessed here through the
United States Government Printing Office. If these resources do
not meet your needs or
you find better resources for federal legal research, please
contact Center staff at
[email protected]
http://www.nao.edu/books/0309026461
http://access.wa.gov/government/awlaws.asp
http://michiganlegislature.org/law/GetObject.asp?objName=333
-21765a
http://michiganlegislature.org/law/GetObject.asp?objName=333
-21765a
http:// www.law.cornell.edu/
http://www.access.gpo.gov/
mailto:[email protected]OBRA ‘87 SUMMARY